By Richard Blitstein L.Ac., MSTOM, Dipl. Ac., Dipl. CH

In my last article in Hope, I discussed a number of scientific studies that have shown the effectiveness of Traditional Chinese Medicine (TCM) in helping women to enhance their fertility. In this issue, I examine how TCM works and what women can expect from TCM treatment.

In order to understand TCM treatment for infertility, it is important to know a little about the theory behind this ancient healing art. The foundation of Chinese medicine lies in the Taoist concepts of yin and yang. Yin represents all that has the nature of substance, tranquility, darkness, downward movement, and cold. Yang on the other hand represents energy, activity, brightness, upward movement, and heat. These opposites are not natural forces or material objects but instead ways of describing the continuous process of natural change in the world around us as well as inside us. Clear manifestations of these ideas can be seen in such natural phenomena as the change of seasons or in a women's menstrual cycle.

The Yin and Yang of the Menstrual Cycle

On Day 1 of the menstrual cycle, the menses begins to flow down and out of the body. This is the beginning of the yin part of the cycle. After 5 to 7 days, the menstrual flow stops and the body begins to make up for the blood lost. According to TCM, this is the time when the yin of the body builds and accumulates. As the body approaches Day 14, the blood is back to its normal level and the body is ready ovulate. It is at this peak of yin that we also see the cervical mucous become heavier and thicker. One of the fundamental ideas of yin-yang theory is that as the yin reaches its peak it transforms into yang. It is with ovulation on or around day 14 that this energetic and physical change takes place. The cold tranquil yin transforms into the hot active yang. We can see the reflection of this ancient idea in the modern knowledge that this is the point when basal body temperature spikes. It is during this active yang phase that fertilization of the egg may take place. If fertilization does not take place, this yang part of the cycle continues until reaching its peak just prior to menstruation. It is all of this hot, active energy building in the body that can cause many of the well-known premenstrual symptoms if the body is out of harmony. As menses begins, the yang reaches its apex and transforms into yin, beginning the cycle once again.

The TCM View of the Body

The primary goal of TCM fertility treatment is to adjust this natural cycle and bring it back into balance. Once this goal is accomplished, a woman will have a much higher possibility of becoming pregnant. If there are other specific problems-such as blocked fallopian tubes, fibroids, or sperm antibodies-these are addressed at the same time.

TCM views the person as one unified system, taking into account all aspects of the body's functioning when diagnosing and treating disorders. For this reason, the initial TCM visit gathers an extensive amount of patient information, including not only gynecological information but also information about the patient's digestion, sleep patterns, and energy level. Because TCM existed for 2,000 years before Western lab tests, it uses other methods to provide the practitioner information about the internal state of the patient's body. For example, great emphasis is placed on the appearance of the tongue and the feeling of the pulse-which demonstrate the health of all of the body's organ systems. Western lab tests and imaging are also important tools that traditional Chinese practitioners use today. Ultrasounds and blood hormone levels all provide practitioners with a better picture of the internal state of a patient's body. A practitioner might also want patients to start charting their basal body temperature (BBT), to provide insight into how the yin and yang of the menstrual cycle is fluctuating.

TCM Theory and Therapy

The primary goal of TCM is to restore the patient's normal state of balance and harmony. One way this is achieved is by manipulating the flow of energy (Qi) in the body using acupuncture. Acupuncture is based on the concept that there are channels of energy that flow throughout the body. Different points along the channels have different effects on the internal organs and on the body as a whole. Points are selected by the practitioner, according to the individual needs of the patient. Points may be chosen to move blocked energy in the channels, supplement a physiological process, or affect a specific organ system.

Acupuncture is performed with extremely thin sterilized disposable needles inserted superficially at specific points on the body. The needles are usually left in for 20-30 minutes. Typically, the patient experiences little or no pain, and most people feel that the treatment is very relaxing and grounding. Treatments are usually done once or twice per week or at specific times related to assisted reproductive procedures.

Chinese Herbal Medicine for Increased Fertility

In addition to acupuncture, Chinese herbal medicines are used to nourish, support, and strengthen the Qi and the vital fluids (including blood), as well as the internal organs. For patients in the United States, who often have delayed child-bearing until later in life, these ideas are especially significant. As the body ages and is subjected to the stresses of modern life, various energies and fluids in the body become depleted and stagnant. This is especially true of the kidneys and liver, which Chinese medicine sees as highly important for maintaining the menstrual cycle, fertility, and pregnancy. While most reproductive endocrinologists prefer that their patients undergoing assisted reproductive procedures do not take herbs while also taking fertility medications, the herbs can be highly effective if taken either before or after such intervention.

The TCM practitioner selects from more than 450 Chinese herbs in common use to create a formula tailored to the individual's specific needs. A formula usually contains between 10 and 16 different herbs, which work together in a balanced way, achieving the treatment goals without producing side effects.

In the treatment of fertility issues, it is extremely important that the herbal medicines follow the natural rhythms of the woman's cycle. During menses, the movement of blood is emphasized so that the body can clear out the old uterine lining thoroughly, making room for a fresh layer. Immediately following the menses, the blood is nourished so that the body can replace what has been lost. Around ovulation time, yin is supplemented to promote the growth of the new egg, and, following ovulation, yang is supplemented to give energy for the process of fertilization and implantation in the uterus. By following a woman's natural cycle, herbal medicines can help in each part of that cycle, correcting for irregularities that may be causing problems with fertility.

TCM and In Vitro Fertilization (IVF)

Those being treated for infertility with Chinese medicine alone should not expect to achieve pregnancy immediately. The process can take up to six months and occasionally-in especially difficult cases-up to a year. It takes some time to bring the body into balance, regulate the menstrual cycle, and create an environment favorable to pregnancy. An IVF procedure, on the other hand, may well work the first time it is performed. It is however mildly invasive and can be very stressful for the woman.

These two modalities work very well in conjunction, attaining very high rates of pregnancy as I outlined in my last article. In addition, among those for whom IVF has proved unsuccessful or for those who would like to try a different approach, TCM offers an option that has been used by millions of people for more 2,000 years.

In a future issue of Hope, I will explore how traditional Chinese medicine can help male infertility.

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